Posts Tagged ‘breast cancer’

Shawn Ware felt a small lump in her breast while in the shower on January 2nd, 2009, and on that day, the journey on the fight against breast cancer began for Shawn, her husband Albert, daughter Demitria, son Jalen, and mother Eva Freeman. As part of her treatment plan, Shawn underwent a lumpectomy and additional treatment with radiation therapy and chemotherapy.

Shawn Ware

“You know those side effects that you see in fine print? I had all those and more,” she says, somehow able to laugh about them now. “I didn’t know that your eyelashes act as windshield wipers, and when I lost mine, I had to wear glasses just to keep things from getting in my eyes.”

Shawn triumphed. “I was ready to conquer the world after my last round of radiation,” she says. And three years later, she is considered a survivor and a reason for celebration.

“Cancer, it stinks,” says Shawn, the general manager of Blomeyer Health Fitness Center at Emory. “But you do change. You certainly learn to appreciate the good and not let the little things bother you any more.”

Like millions of other Americans, Shawn is part of a growing trend—more people than ever are surviving cancer. In just six years, the number of cancer survivors has jumped by almost 20 percent, according to the Centers for Disease Control and Prevention and the National Cancer Institute—11.7 million in 2007, up from 9.8 million in 2001, the most recent years available.

The good news comes with some challenges, however. As cancer treatment has become more successful, survivors —and their caregivers and providers—have learned that there is a cost to surviving.

“Long-term survivorship starts on the day treatment ends,” says nurse practitioner Joan Giblin, the director of Winship’s new Survivorship Program. “You’re actively doing something during treatment, but when treatment ends, many patients tell us they feel like they have been set adrift without a clear course. Our survivorship program is trying to bridge that gap and provide survivors with tools for these difficult times.”

Giblin says that some survivors respond by isolating themselves. Still others “jump right back into their old lives or try to adjust to a new life by adapting to any after-effects they may still be experiencing.”

Survivors of all types of cancer can face myriad physical issues. Treatment itself can be so hard on the body that survivors sometimes suffer chronic pain, heart problems, depression, sexual dysfunction, and a mental fogginess dubbed “chemo brain.” They also are at heightened risk for recurrence and secondary cancers.

Physical problems arise within individual cancer groups. For example, head and neck cancer patients often have trouble swallowing and lose their sense of taste. Breast cancer patients must deal with the changes that come as a result of a lumpectomy or mastectomy and reconstruction.

In addition, family and relationship problems may arise as all in a survivor’s relationship network struggle to adjust to cancer and life after cancer. Emotional challenges abound, from sadness, fear, and anger to serious depression. Fatigue is common.

Winship Cancer Institute is helping survivors deal not only with the late physical effects of cancer but also with the psychological and social issues that are part of surviving.

“We are now defining a ‘new normal’ for these patients,” says Giblin. “There can be long-term after-effects when treated for cancer, and we are finding ways to improve their quality of life while providing guidance on strategies for dealing with these after-effects.”

The Winship Survivorship Program officially started in November, 2011. Already more than 10 Winship survivorship “clinics” are being offered, focusing on survivors of 10 different cancer categories. The program holds workshops on such vital topics as nutrition, preventing lymphedema, how to talk to children about cancer, spirituality and pet therapy. Workshops have been held on sexuality and also on fatigue. In May, Winship announced its collaboration with the YMCA of Metro Atlanta for a special exercise program for cancer survivors. A unique collaboration, Winship at the Y was Giblin’s brainchild. She is at the hub of a very extensive interdisciplinary wheel that involves specialists from a wide range of treatment areas, including nutrition, pain management, and psychiatry to help survivors thrive.

“We have to change how we look at cancer patients,” Giblin says. “Many cancers are not curable in a conventional sense, but the improvement in the quality and quantity of life needs to be our priority. Much as we view diabetes as a chronic condition, we must look at many cancers in the same way.”

Head and neck cancer survivor Barry Elson, 70, had difficulty swallowing after his treatment. Barry, who was first diagnosed in 2003, had an esophageal dilation last year to improve his ability to swallow.

“I think in the press of your day-to-day survivorship, you forget to ask what (the treatment) might do to your long-term quality of life,” Barry says.

Shawn found that exercise has not only helped her gain physical strength but also has helped her mental outlook. Shawn was able to exercise throughout most of her treatment, even as ill as she was. Now, her worst worry is fatigue. But that doesn’t slow her down. In her job as fitness manager at Blomeyer, she conducts “boot camp” training sessions and teaches other classes.

Winship is also helping survivors thrive by providing support services to help survivors cope with employment and insurance issues that arise as a result of their cancer.

“After treatment,” Giblin says, “patients tend to not be able to work as long, and they don’t have the stamina they used to have.” In addition, there can be stigma in the workplace against a cancer survivor, which in times of layoffs, can result in their loss of employment and consequently, loss of benefits.

“It’s the people who can’t afford to lose their jobs who do,” she says.

And even in cases where survivors keep their insurance benefits, they might find a lack of integrated care as they celebrate more birthdays.

Paper records are lost through the years, hospitals and oncology offices change and primary care physicians—who don’t have experience in oncology —aren’t prepared or educated to provide the ongoing care cancer survivors need.

Despite the side effects she faced during treatment, Shawn says she has grown from her cancer experience.

It makes her a stronger survivor, she says, and also more hopeful, optimistic, and motivated.
“It’s almost motivated me to do more,” she says. “It really helps me to live day by day. You make every day everlasting.”

Substantial research conducted over the last few decades demonstrates that being overweight at the time of a breast cancer diagnosis may result in less favorable outcomes. This information—coupled with the fact that many women are indeed overweight at the time of their breast cancer diagnosis and additional weight gain during treatment is frequently reported—means that for a woman diagnosed with breast cancer, achieving or maintaining a desirable weight may be one of the most important lifestyle pursuits they can make in the interest of their overall health and wellness.

Much of the research around breast cancer has supported the theory that excess weight at the time of diagnosis can lead to a worse prognosis. Recently, analyses conducted on a group of nonsmoking breast cancer survivors corroborated these findings. According to the study’s findings, women who increased their body mass index (BMI) by 0.5 to 2 units were found to have a 40% greater chance of breast cancer recurrence, and those who gained more than 2 BMI units had a 53% greater chance of recurrence. Data suggests that being overweight or obese adversely influences not only cancer-specific outcomes, but also overall health and quality of life. As a result, weight management is now considered a priority standard of care for overweight women diagnosed with early stage breast cancer.

Research around breast cancer also suggests that the weight gain experienced by women who have undergone chemotherapy or hormone treatments seems to be the result of increased tissue mass, with no change or a decrease in lean body mass. This unfavorable shift in body composition suggests that steps should be taken to not only curb weight gain during treatment, but also to preserve or rebuild muscle mass. Moderate physical activity (especially resistance training) during and after breast cancer treatment may help survivors maintain lean muscle mass while avoiding the accumulation of excess body fat.

Additional research is currently under way to evaluate the effects of dietary patterns on cancer-specific outcomes, as well as overall health. One observational study found that dietary pattern was important for overall survival among breast cancer patients, with those who ate a Western diet having poorer overall survival and those who ate a dietary pattern characterized by high amounts of fruits, vegetables, and whole grains having better survival rates overall. Furthermore, this theory is supported by data on breast cancer survivors participating in the Nurses’ Health Study. Participants were followed for nearly 10 years post-diagnosis, and study findings suggest that those who consume a healthy diet, with higher intakes of fruits, vegetables, and whole grains and lower intakes of added sugar, refined grains, and animal products, may not have had significantly lower rates of recurrence or cancer-specific mortality.

A topic of controversy as it relates to breast cancer risk and prognosis is alcohol consumption. Alcohol is an unusual factor, as it presents both risks and benefits to those with breast cancer. In the general population, clear and consistent evidence links moderate alcohol intake (1-2 drinks per day) with a lower risk of cardiovascular disease. For breast cancer survivors, however, the decision to drink alcoholic beverages at moderate levels is complex because they must consider their levels of risk for recurrent or second primary breast cancer as well as cardiovascular disease. See our post on the relationship between alcohol and breast cancer for more information.

It is important to remember that lifestyle, nutrition and physical activity recommendations to reduce the risks of a second primary breast cancer and heart disease are especially important for breast cancer survivors. Diet for those at high risk for breast cancer or with a breast cancer diagnosis should emphasize vegetables and fruits, have low amounts of saturated fats, and include sufficient dietary fiber. Most importantly, breast cancer patients and survivors should strive to achieve and maintain a healthy weight through eating a well-balanced diet and regular exercise. In addition, regular physical activity should be maintained regardless of any weight-related concerns.

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We recently held a live web chat with Heather Pinkerton, RN, BSN, OCN and Nurse Navigator for the Emory Breast Center. During the discussion Heather Pinkerton answered questions about Breast Cancer diagnosis, treatment and survivorship. Below you’ll find heather’s main highlights from the chat discussion.

The American Cancer Society estimated that for 2012, a total of 229,060 new cases of breast cancer would be diagnosed in both men and women in the United States. In honor of October’s Breast Cancer Awareness Month, participants joined Heather Pinkerton for a live web chat on the topic of breast cancer.

Heather recommended that the general population of women begin screening mammograms at age 40. It should also be noted that if a person has a family history of breast or ovarian cancer, screening mammograms can and should start sooner. Potentially high-risk patients are advised to speak with their personal physician about what age is right for them to begin screening. For those concerned about being a potential high risk patient, The Emory Breast Center at the Winship Cancer Institute has a High Risk Assessment Clinic available. The clinic provides a comprehensive consultation that will include visits with a genetic counselor and breast surgical oncologist. At the end of each consultation, an individual care plan will be provided to each patient including recommendations for regular screenings and follow-up appointments.

Genetic tests are available to identify individual breast and ovarian cancer risk levels. These genetic mutation tests are known as BRCA 1 and BRCA 2. Anyone interested in undergoing these tests should speak with a genetic counselor regarding cost and specifics on coverage.

We also learned from Heather’s discussion in the chat that studies have shown that the relationship between taking birth control pills and developing breast cancer is insufficient to establish a cause-effect link between the two.

If you or someone you know is in need of support through their cancer journey, the Winship Cancer Institute has a several support groups pertaining to breast cancer, monthly at various locations. You can check out the event calendar here.

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The American Cancer Society estimates that a total of 229,060 new cases of breast cancer will be diagnosed in both men and women in 2012. In honor of October’s Breast Cancer Awareness Month, Emory Healthcare and the Winship Cancer Institute of Emory University have partnered with organizations across Atlanta to host events and help raise awareness around breast cancer throughout the month. A detailed listing of events is below:

National Mammography Day
Description: The third Friday in October each year is National Mam-mography Day, first proclaimed by President Clinton in 1993. On this day, and throughout the month, women are encouraged to make a mammography appointment. In celebration light refreshment tables will be set up at both the Clifton and Midtown Breast Imaging Center Lobbies.
Date: Friday, October 19.2012
Registration: To schedule an appointment, call (404) 778-PINK (7465).

Ready, Set, Pink!
Description: Join Bloomingdales and representatives from Winship Cancer Institute for a fall fashion presentation and complimentary skincare consultations by Lancôme. 10% of all purchases go to Winship and the fight against breast cancer.
Date: Tuesday, October 23, 2012
Details: 11:00 a.m. at Bloomingdales at Lenox Square, Level 2, The New View
Registration: RSVP by October 18 by calling 404-778-1769 or emailing winshipevents@emory.edu

The American Cancer Society estimates that in 2012, a total of 229,060 new cases of breast cancer will be diagnosed in both men and women. In honor of October’s Breast Cancer Awareness Month and to help our community get their questions answered, we are hosting an online chat on the topic of breast cancer.

Join Heather Pinkerton, RN, BSN, OCN and Nurse Navigator for the Emory Breast Center, on Tuesday, October 16, 2012 to get all of your questions on breast cancer—ranging from diagnosis, to treatment, to survivorship—answered.

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Maintaining a healthy diet is important, especially during cancer treatment. Your body is stressed– both from the treatment and cancer itself. It’s imperative to make sure that you’re getting the proper nutrition, vitamins, and minerals you need to stay strong and fight infections.

According to the American Cancer Society’s (ACS) Nutrition Guidelines, it’s best to eat a diet consisting of plant-based foods like fruits, vegetables, grains, and foods low in fat.

Omer Kucuk, MD and Professor of Hematology and Medical Oncology at Winship Cancer Institute of Emory University says, “there are bioactive compounds in foods, particularly in fruits and vegetables. These bioactive compounds have potent anti-cancer activities; for example, broccoli contains indole 3 carbinol, which has been shown to have anti-cancer affects, especially in prostate cancer and breast cancer.”

While certain foods have been show to help prevent cancer, evidence also shows that specific food compounds, such as soy isoflavones and curcumin, can increase the effectiveness of cancer treatment.

“We have found that soy isoflavones enhanced the efficacy of cancer treatment, specifically the efficacy of chemotherapy and radiation therapy. In addition to that, soy isoflavones may also prevent the side effects of these two cancer treatments,” reports Dr. Kucuk. Soy isoflavones are plant-derived compounds with estrogen-like activity that may help protect against hormone-dependent cancers according to ACS. Get more information on soy isoflavones and how proper nutrition can help during cancer treatments.

More in-depth studies are currently underway to find which bioactive compounds in foods aid in cancer treatment and reduce the risk of cancer recurrence. The American Cancer Society reports “that a higher intake of vegetables may have a helpful effect on recurrence or survival for breast, prostate, and ovarian cancers, but this is not definite.”

Still, ACS recommends that cancer survivors get at least five servings of colorful fruits and vegetables each day due to the overall benefit they provide. All cancer and cancer treatments affect the body differently. An individualized nutrition plan based on your likes and dislikes, and what your stomach can handle, is going to be beneficial during your treatment journey. A registered dietitian can help you and your family answer questions and address concerns about managing your diet, weight, treatment side effects, and supplement information.

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Recent news that even a small bit of alcohol consumption increases a woman’s risk of breast cancer got me thinking. The authors of the study, published in early November in the Journal of the American Medical Association, talked in news media interviews about the fact that many respondents might actually have under-reported their alcohol consumption. They went on to say that it is very important to accurately report your lifestyle habits when your doctor asks.

So here’s what got me thinking. A few years back, I had a breast cancer scare. Perhaps the fear made me especially conscientious about reporting any bad habits – you know, fear being a powerful motivator and all.

When the nurse asked me about whether I smoked, I was able to honestly answer a resounding “NO!” When she asked whether I exercised, I was able to report honestly that I exercise at least five days a week. Then, when she asked whether I drank and how much, that one had me a little nervous.

I don’t know what it was – stress, too much travel associated with my job or just the plain seductive powers of alcohol and my own enjoyment of it – but I was a bit concerned about my alcohol consumption. During that time of my life, I was drinking probably seven to 10 drinks a week, way more than I ever did in the past. I had been a little worried, but, wow, with the thought of a 3 cm mass in my breast, I was really concerned. Time to ‘fess up and come out with the truth, which I did at that time and planned to continue to do when I later sought a second opinion.

It was a few months later when I sought that opinion. To prepare for my visit, I asked for records from the hospital at which I had previously sought treatment (I did not have breast cancer, but still had many questions about the mass). I got the records, checked them out, and there on the exam notes, it said that “patient reports having 10 shots of alcohol a day.” Holy moley! I almost fell off my chair.

In my first visit, I had disclosed to my nurse that I was consuming between 7-10 drinks per week. I was shocked to see such a glaring error when that number was erroneously reported as 7-10 drinks per day! The word “shot” also really got to me!

Images of me stumbling up to a bar, saying “hit me again, sister” came to mind. Ten shots a day? I wouldn’t have been able to work, drive or even eat, it seemed to me.

The incident brought home a few things to me. First, how important it is to be transparent with your medical team and to make sure you are aware of the content of your medical records. In hindsight, if I had seen my records earlier, I would have been able to correct the misreporting of my information. Furthermore, if the information they thought I disclosed about my drinking was alarming, I wish we would have discussed it. If this step had been taken, it would have clarified the errors in my records and also, would have made me feel more comfortable as a patient knowing my care team was on top of it and truly cared about me.

So when this recent news story came out about a slightly elevated risk of breast cancer existing in women who drink even moderately, I realized a few things. First, I need to take ownership of my health, including all my lifestyle issues and behaviors that can affect my risk of getting cancer. That means not smoking, getting regular exercise, little to no drinking, eating lots of fruits and vegetables, avoiding excessive sun exposure and maintaining a healthy body weight.

It also means enlisting the aid of my healthcare providers and asking them for help in my problem areas. And it means absolute transparency is required when I report my lifestyle habits – as is making sure my habits are recorded accurately! This has changed the way I think about who plays a role in my care. Through this experience I have realized that I must take part in and own my healthcare and partner with providers I trust are willing to help fill in any gaps I may leave behind.

Most of us have heard that moderate drinking – a glass of wine a day – can be beneficial in preventing heart disease.

A study published in the Journal of the American Medical Association in early November, however, suggests that even moderate alcohol consumption can increase a woman’s lifetime risk of developing breast cancer. Alcohol use already has been linked to oropharyngeal cancers, esophageal and, to lesser degree, stomach and colon cancers, so what does this news mean to you as you go into the holidays?

It doesn’t mean that you shouldn’t imbibe, but it does mean that you should be aware that alcohol is considered a carcinogen.

Here are six things to think about as you get ready for the parties and the tree-trimming.

The JAMA article reported that women who drank three to six alcoholic beverages a week had a 15% increased risk of breast cancer. Women who consumed two drinks per day had a more than 50% greater risk than women who did not drink.

If you drink to decrease your risk of heart disease, reconsider. There are far better ways to do that, experts suggest, than by having an alcoholic beverage. Regular exercise, weight control, not smoking, controlling blood pressure and cholesterol and healthy eating are all more beneficial. While it may be hard to factor in gym time during the holidays, try to manage at least a brisk walk of 30 minutes each day.

Lifetime consumption of alcohol may be a factor in cancer risk, the authors of the study suggest. Cumulative consumption of alcoholic beverages over a period of years appears to place a woman at higher risk of developing breast cancer. Thus, if you are an older woman – particularly post-menopausal when excess body fat increases the amount of circulating estrogen in the body – think about slowing down the flow of alcohol.

“But I only drink a few drinks once a week,” such as at a party, dinner or girls’ night out, you might think. Doesn’t matter, the experts say, and binge drinking – typically defined as drinking three or more drinks in one setting – may actually be more detrimental than three drinks spread over the course of a week.

Consider the effect on your body of the empty calories of alcohol. A glass of wine is 125 calories; a martini is about 190. To burn off the martini, you would need to walk about 45 minutes or swim about 20.

The study’s authors – as well as many other researchers – note that alcohol consumption is often under-reported. That is, patients do not typically like to tell their doctors how much they drink. Remember that your physician is there to keep you healthy or to heal you, not judge. Make sure you accurately report your drinking patterns to him or her.

We held a chat on the topic of breast cancer with Dr. Toncred Styblo in October. From that chat, we got lots of great questions and feedback and even a couple questions we couldn’t get to in the chat’s allotted time. Dr. Styblo has taken the time to answer those questions for this follow up blog post, mostly covering questions related to ductal carcinoma in situ (DCIS), a type of breast cancer typically found in the lining of the milk ducts that has not yet invaded nearby tissues.

Below are the questions Dr. Styblo has covered in this post:

How long does one continue to follow up with oncologist and surgeon after DCIS diagnosis and resultant mastectomy?

What is the risk of recurrence in other breast after DCIS and mastectomy?

Does that include blood work for Ca27-29, and how often?

I’m interested in risk of recurrence after DCIS diagnosis. If you continue to follow your patients for life (which Dr. Styblo mentioned in the chat that she does), that suggests a moderate risk for recurrence.]

What would you suggest in the case of multifocal DCIS?

Answers from Dr. Styblo:

DCIS, intraductal cancer and in situ ductal cancer are names for stage “0” breast cancer. Stage 0 breast cancer is cured by removing it completely with surgery, but does not have any affect on the risk of developing a second breast cancer in that breast or the other breast.

The surgery to remove the cancer may be a lumpectomy or it might be a mastectomy. This risk of a patient developing another breast cancer post-surgery is dependent on many factors and the risk is best assessed by your doctor. The subsequent follow up and recommendations about screening and risk reduction will be dependent on additional factors including the pathologic features of the DCIS and the patient’s risk of developing a second breast cancer.

Because DCIS is stage 0 breast cancer, follow up is primarily to screen for another breast cancer rather than recurrence. The screening includes breast imaging and clinical exam, there are no blood tests indicated.

Dr. Styblo also received a question on the topic of support in the chat: What role, in your opinion does emotional support play in achieving the best possible outcome after breast cancer? Where or how do you recommend patients find advocates? The Winship Cancer Institute has several programs for survivors and support, including the Peer Partner Program which “matches cancer survivors and caregivers with cancer patients and caregivers dealing with a similar diagnosis of cancer, pre-cancerous condition, or benign tumor.”

In November of last year, right after Breast Cancer Awareness Month wrapped up in October, we pledged to keep pushing for breast cancer awareness year-round. It’s been almost a year since that date, and we’ve made some great strides in raising community awareness and action around breast cancer.

September 2010 – Emory Healthcare launched an overhauled breast health microsite to provide educational resources on breast health and breast cancer to web users. Website release is followed by launch of Emory Healthcare and Winship at Emory cancer blog.

Feburary 2011 – The Emory Breast Center and Winship Cancer Institute partnered with Georgia Tech women’s basketball again, this time for their “PINK” game. Breast cancer survivors joined together to form the tunnel the Lady Yellow Jackets ran through to enter the game.

March 2011 – The Winship Cancer Institute of Emory University received a high impact donation from the Wilbur and Hilda Glenn Family Foundation in the amount of $5 million. The donation contributes to supporting breast cancer patient care, research, education and community outreach.

All of our team members from Emory Healthcare, the Winship Cancer Institute and the Emory Breast Center would like to thank our community for helping us make this an awesome year for breast cancer prevention awareness. We have lots more to do to keep the momentum going!

In the comments below, we’d love it if you’d share with us an example of something you’ve done over the last year to help promote breast cancer awareness.

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About Winship at Emory

Winship Cancer Institute of Emory University, Georgia’s only National Cancer Institute-designated cancer center, serves as the coordinating center for cancer research and care throughout Emory University and Emory Healthcare. Seeing more than 14,000 patients each year, Winship at Emory offers patients with access to progressive resources, technology and cancer treatment options. To benefit from these investigational advancements in cancer treatment, it is important to seek care from an academic medical center like Winship at Emory, first. Through discoveries made possible by a dedicated team of many of the nation’s best physicians and researchers, Winship at Emory works hard toward a future when science triumphs over cancer.

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